We have both spent most of our working lives providing mental health care in one form or another. Although there are differences in our experiences—in age, sector, specialty and need—we have found commonality in many things. These diverse and varied perspectives have and continue to enrich our practice as registered mental health nurses. We challenge one another and agitate in the ‘ecology’ of our organisations, and wider healthcare systems. We fly the flag for equity of access, treatment and outcome for people with mental health needs.
Most recently, we have both found ourselves taking up mental health nursing roles in large acute hospitals. Whether with oversight of the strategic development of an organisation, or a focus on the complexity of mental health and wellbeing in long-term conditions, for both of us, things have never felt so ‘other side’.
Past experiences of transferring patients between hospital sites for admissions, observations and investigations continually raised the questions do acute hospitals understand mental health? Or worse, do they even care? Are our patients, who are equally as deserving of treatment as the physically ill, getting a ‘raw deal’? Conceivably, these questions and experiences only further reinforced a counterproductive ‘them and us’ dynamic—rooted in the professional silos in which we train and practice.
Attempting to uncover ‘what we don't know that we don't know’ challenges us to look to the unknown and find newness. It challenges us to understand and celebrate difference, rather than label it as alien. Trying to imagine what life is like for someone else is a goal of mental health nursing; to develop empathy leading to a level of understanding that helps us to provide the care that is needed.
With this principle in mind, we have spent the past 3 years developing bespoke training for nurses with a local acute hospital trust. This collaboration has engaged clinicians at the frontline of care delivery, where there is a need to understand the day-to-day ‘symptoms’ of inequitable services; and senior leaders to achieve sustainable, systemic change. With each iteration this ‘reciprocal learning programme’ continues to grow in scope and effectiveness and is being rolled out across adult and children's services, with older adults soon to follow. The courses have been based on a model developed in-house at South West London and St George's Mental Health NHS Trust with our colleague Catherine Gamble and acute partners Julie Goldie and Daryl Desmond from St George's University Hospitals NHS Foundation Trust.
Recently, landmark reforms to the Mental Health Act were announced in a new government white paper. Excitement increased when reading that steps will be taken to ensure parity of esteem between mental and physical health—to ‘level up’ access and facilities, creating modern and genuinely therapeutic environments.
Although such commitment is essential to ensure a future in which mental health services stand on equal footing with physical health services, our work has taught us that integration sits at the very heart of parity of esteem. And integration does not exist in bricks and mortar. While this gulf between mental and physical health remains, the stakes will continue to be high, and when we don't get it right, the lessons will be harsh. Nurses at the helm of service development and delivery take up this challenge, doing their best to move towards integration and supporting all to not just survive, but to thrive. Experience has taught us that this starts with a willingness to venture into that ‘other side’. To recognise that many of the things we perceive to make us different as nurses, are the things that make us the same: the desire to do the best for the whole person, juxtaposed by the fear of not being able to offer enough. We are them, and they are us.
‘When thinking about providing services that realise parity of esteem, there can be no ‘us and them’ only ‘us’
For us, learning should be transformative. The lessons learnt from this work, and in working in acute settings, has crystallised this. When thinking about providing services that realise the ambition of parity of esteem, there can be no ‘us and them’, only ‘us’. Moving to an acute hospital Trust has been eye-opening, particularly in the current pandemic. It was difficult to imagine how busy and dedicated the teams are without having witnessed it. The welcome has remained exceptionally warm despite the challenges.
Exposure to different perspectives has highlighted how much we need each other to succeed at this goal. We must continue to create the spaces that allow for this shared learning and healing. Spaces in which interests are more important than status, where contributions, challenges and opportunities are considered instead of criticising and apportioning blame. This space will enable others to learn the lessons we have been fortunate enough to learn, and experience a version of their own transformation.